scholarly journals Current concepts and outcomes in cemented femoral stem design and cementation techniques: the argument for a new classification system

2020 ◽  
Vol 5 (4) ◽  
pp. 241-252 ◽  
Author(s):  
Adrian J. Cassar-Gheiti ◽  
Rosie McColgan ◽  
Martin Kelly ◽  
Theresa M. Cassar-Gheiti ◽  
Paddy Kenny ◽  
...  
Keyword(s):  
Classification System ◽  
Femoral Stem ◽  
Implant Fixation ◽  
Stem Design ◽  
Heterogenous Group ◽  
Respective Type ◽  
Comprehensive Classification ◽  
Cemented Implants ◽  
Cementing Techniques

Cemented implant fixation design principles have evolved since the 1950s, and various femoral stem designs are currently in use to provide a stable construct between the implant–cement and cement–bone interfaces. Cemented stems have classically been classified into two broad categories: taper slip or force closed, and composite beams or shaped closed designs. While these simplifications are acceptable general categories, there are other important surgical details that need to be taken into consideration such as different broaching techniques, cementing techniques and mantle thickness. With the evolution of cemented implants, the introduction of newer implants which have hybrid properties, and the use of different broaching techniques, the classification of a very heterogenous group of implants into simple binary categories becomes increasingly difficult. A more comprehensive classification system would aid in comparison of results and better understanding of the implants’ biomechanics. We review these differing stem designs, their respective cementing techniques and geometries. We then propose a simple four-part classification system and summarize the long-term outcomes and international registry data for each respective type of cemented prosthesis. Cite this article: EFORT Open Rev 2020;5:241-252. DOI: 10.1302/2058-5241.5.190034

Prospective clinical study using radiostereometric analysis (RSA) to evaluate fixation of a modular cemented polished femoral stem

2019 ◽  
pp. 112070001988142
Author(s):  
C Glen Richardson ◽  
Elise K Laende ◽  
Michael Gross ◽  
Michael J Dunbar
Keyword(s):  
Clinical Success ◽  
Femoral Stem ◽  
Prospective Clinical Study ◽  
Radiostereometric Analysis ◽  
Stem Design ◽  
Modular Stem ◽  
Long Term Follow Up ◽  
Post Operation ◽  
Design Type

Background: The long-term clinical success of cemented polished tapered femoral components has been demonstrated in prospective as well as registry studies. This stem design type has also been well studied with radiostereometric analysis (RSA) and provides a standard to evaluate alternative designs of polished tapered cemented femoral components. This prospective study evaluates the subsidence of a polished cemented stem with a modular neck design utilising RSA. Methods: 26 patients were prospectively enrolled in the study and 23 were available for RSA analysis at 2 years. Results: The average subsidence of the femoral implant was 1.1 mm (SD 0.4 mm) at 2 years post operation. There were no revisions in this group, specifically no failures of the modular stem-neck design as has been seen with other implants. Conclusions: The RSA subsidence pattern at 2 years of this cemented femoral stem is similar to other successful designs with long-term follow-up. The implications over time of stem neck modularity for cemented polished tapered femoral components requires further evaluation.

scholarly journals A New Classification System to Predict Functional Outcome after Laryngectomy and Laryngopharyngectomy

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1474
Author(s):  
Stefan Grasl ◽  
Elisabeth Schmid ◽  
Gregor Heiduschka ◽  
Markus Brunner ◽  
Blažen Marijić ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Classification System ◽  
Salvage Surgery ◽  
Tumor Resection ◽  
Previous Treatment ◽  
Extent Of Resection ◽  
Voice Rehabilitation ◽  
Pharyngocutaneous Fistula ◽  
Oral Nutrition

(1) Objective: To evaluate long-term functional outcome in patients who underwent primary or salvage total laryngectomy (TL), TL with partial (TLPP), or total pharyngectomy (TLTP), and to establish a new scoring system to predict complication rate and long-term functional outcome; (2) Material and Methods: Between 1993 and 2019, 258 patients underwent TL (n = 85), TLPP (n = 101), or TLTP (n = 72). Based on the extent of tumor resection, all patients were stratified to (i) localization I: TL; II: TLPP; III: TLTP and (ii) surgical treatment (A: primary resection; B: salvage surgery). Type and rate of complication and functional outcome, including oral nutrition, G-tube dependence, pharyngeal stenosis, and voice rehabilitation were evaluated in 163 patients with a follow-up ≥ 12 months and absence of recurrent disease; (3) Results: We found 61 IA, 24 IB, 63 IIA, 38 IIB, 37 IIIA, and 35 IIIA patients. Complications and subsequently revision surgeries occurred most frequently in IIIB cases but rarely in IA patients (57.1% vs. 18%; p = 0.001 and 51.4% vs. 14.8%; p = 0.002), respectively. Pharyngocutaneous fistula (PCF) was the most common complication (33%), although it did not significantly differ among cohorts (p = 0.345). Pharyngeal stenosis was found in 27% of cases, with the highest incidence in IIIA (45.5%) and IIIB (72.7%) patients (p < 0.001). Most (91.1%) IA patients achieved complete oral nutrition compared to only 41.7% in class IIIB patients (p < 0.001). Absence of PCF (odds ratio (OR) 3.29; p = 0.003), presence of complications (OR 3.47; p = 0.004), and no need for pharyngeal reconstruction (OR 4.44; p = 0.042) represented independent favorable factors for oral nutrition. Verbal communication was achieved in 69.3% of patients and was accomplished by the insertion of voice prosthesis in 37.4%. Acquisition of esophageal speech was reached in 31.9% of cases. Based on these data, we stratified patients regarding the extent of surgery and previous treatment into subgroups reflecting risk profiles and expectable functional outcome; (4) Conclusions: The extent of resection accompanied by the need for reconstruction and salvage surgery both carry a higher risk of complications and subsequently worse functional outcome. Both factors are reflected in our classification system that can be helpful to better predict patients’ functional outcome.

scholarly journals UV Spectral Classification of B Stars

1985 ◽  
Vol 111 ◽  
pp. 411-413
Author(s):  
Janet Rountree ◽  
George Sonneborn ◽  
Robert J. Panek
Keyword(s):  
Classification System ◽  
Classification Criteria ◽  
High Dispersion ◽  
Spectral Classification ◽  
Early Type ◽  
B Stars ◽  
Dimensional Classification ◽  
Early Type Stars ◽  
Comprehensive Classification

Previous studies of ultraviolet spectral classification have been insufficient to establish a comprehensive classification system for ultraviolet spectra of early-type stars because of inadequate spectral resolution. We have initiated a new study of ultraviolet spectral classification of B stars using high-dispersion IUE archival data. High-dispersion SWP spectra of MK standards and other B stars are retrieved from the IUE archives and numerically degraded to a uniform resolution of 0.25 or 0.50 Å. The spectra (in the form of plots or photowrites) are then visually examined with the aim of setting up a two-dimensional classification matrix. We follow the method used to create the MK classification system for visual spectra. The purpose of this work is to examine the applicability of the MK system (and in particular, the set of standard stars) in the ultraviolet, and to establish classification criteria in this spectral region.

Use of small cannulated screws for fixation in foot surgery

2000 ◽  
Vol 90 (5) ◽  
pp. 240-246 ◽  
Author(s):  
AE Burns
Keyword(s):  
Effective Means ◽  
Bone Screws ◽  
Cannulated Screws ◽  
Implant Fixation ◽  
Foot Surgery ◽  
Fixation Failure ◽  
Untoward Event ◽  
Patient Noncompliance

Use of cannulated bone screws, as compared with use of traditional bone screws, has been reported to decrease surgical time, allow for more precise screw placement, and reduce sources of error. Cannulation of the smaller-size screws that are routinely used in foot surgery has not been available until the last few years. This article reports on the use of the small cannulated screws manufactured by Alphatec Manufacturing, Inc (Palm Desert, California). The screw sizes available in the Mini Lag Screw System are 2.7, 3.5, and 4.0 mm. A long-term clinical and radiographic prospective evaluation of 70 procedures performed on 49 patients was conducted. The follow-up time for all patients was 2 years. None of the 70 implants fractured, and seven procedures (in seven patients) resulted in some type of implant-fixation failure. All of the fixation failures, however, appeared to be related to an untoward event or patient noncompliance. These smaller cannulated screws proved to be a reliable and effective means of fixation in foot surgery.

The TransAtlantic InterSociety Consensus (TASC) Classification System in Iliac Arterial Stent Placement: Long-term Patency and Clinical Limitations

2007 ◽  
Vol 18 (2) ◽  
pp. 193-201 ◽  
Author(s):  
Kwang Bo Park ◽  
Young Soo Do ◽  
Dong Ik Kim ◽  
Duk Kyung Kim ◽  
Young Wook Kim ◽  
...  
Keyword(s):  
Stent Placement ◽  
Classification System

SCAPHOID BONE BRUISING – PROBABLY NOT THE PRECURSOR OF ASYMPTOMATIC NON-UNION OF THE SCAPHOID

2007 ◽  
Vol 32 (3) ◽  
pp. 337-340 ◽  
Author(s):  
N. LA HEI ◽  
I. MCFADYEN ◽  
M. BROCK ◽  
J. FIELD
Keyword(s):  
Bone Marrow ◽  
Clinical Outcomes ◽  
Classification System ◽  
Complete Resolution ◽  
Scaphoid Bone ◽  
Bone Bruise ◽  
Radiological Findings ◽  
Non Union ◽  
Bone Bruising

The MRI finding of bone marrow oedema, without fracture, following trauma to the scaphoid has been called a ‘bone bruise’. A similar injury is found in the knee, considered benign and managed conservatively. In the scaphoid, there is the concern that this lesion may lead to scaphoid non-union. This study addresses that concern. The clinical and radiological findings of 41 patients with a scaphoid bone bruise on MRI are described, an MRI classification system proposed and clinical outcomes investigated. Patients were immobilised for 6 weeks. At 3 months, 8 remained symptomatic and had repeat MRI. Four of these showed complete resolution of the bruise, the others improvement. At 6 months, 2 of the 8 complained of minor, intermittent discomfort but progressed to resolution of symptoms. This study suggests that the scaphoid bone bruise is a benign injury with predictable recovery and is unlikely to result in long-term morbidity in the form of non-union.

scholarly journals Early Outcomes of Patient-Specific Modular Cones for Substitution of Methaphysial and Diaphysial Bone Defects in Revision Knee Arthroplasty

2019 ◽  
Vol 25 (2) ◽  
pp. 9-18 ◽  
Author(s):  
A. A. Cherny ◽  
A. N. Kovalenko ◽  
S. S. Bilyk ◽  
A. O. Denisov ◽  
A. V. Kazemirskiy ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Scoring Systems ◽  
Bone Defects ◽  
Patient Specific ◽  
Implant Fixation ◽  
Diaphyseal Bone ◽  
Custom Made ◽  
The Stability ◽  
Valid Solution

The aim of this study was the assessment of early outcomes of patient-specific three-dimensional titanium cones with specified porosity parameters to compensate for extensive metaphysical-diaphyseal bone defects in RTKA.Materials and Methods. Since 2017 till 2019 30 patient-specific titanium cones (12 femoral and 18 tibial) implanted during 26 RTKAS. Clinical outcomes evaluated using KSS, WOMAC and fjS-12 scoring systems on average 10 (2–18) months after surgery. At the same time the stability of implant fixation analyzed using frontal, lateral and axial knee roentgenograms.Results. During all procedures there were no technical difficulties in positioning and implantation of custom-made titanium cones. At the time of preparation of the publication, none of the patients had indications for further surgical intervention, as well as intra- and postoperative complications. Six months after surgery all scores improved significantly: KSS from 23 (2–42, SD 19.96) to 66.5 (62–78, SD 7.68), WOMAC from 59 (56–96, SD 28.31) to 32.25 (19–46, SD 11.76), the index FJS-12 was 29.16 points (0–68.75, SD 30.19). The average scores continued to improve up to 18 months: KSS — 97.5 (88–108, SD 9.14), WOMAC — 16.5 (9–24, SD 6.45), FJS-12 — 45.85 (25–75, SD 22.03). No radiolucent lines were noticed during this period of observation.Conclusion. The original additive technology of designing and producing patient-specific titanium cones for compensation of extensive metaphyseal-diaphyseal bone defects in RTKA is a valid solution at least in the short term. A longer follow-up period is required to assess its medium-and long-term reliability compared to existing alternative surgical solutions.

scholarly journals Fractures of the Lateral Process of the Talus: A New Classification Based on CT

2021 ◽  
Author(s):  
Yuchuan Wang ◽  
Yanbin Zhu ◽  
Xiangtian Deng ◽  
Zhongzheng Wang ◽  
Siyu Tian ◽  
...  
Keyword(s):  
Classification System ◽  
Intraobserver Reliability ◽  
Kappa Statistics ◽  
Type I ◽  
New Classification ◽  
Concomitant Injuries ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Lateral Process ◽  
Comprehensive Classification

Abstract Background: The common classifications of the fractures of the lateral process of the talus（LTPFs）are based on radiographs and may underestimate the complexity of LTPF, therefore, requiring a comprehensive classification based on CT(Computed tomography) scan. The aim of this study is to propose a such classification system, and to evaluate its reliability and reproducibility.Methods: On the basis of the most widely recognized classifications of Hawkins as well as McCrory-Bladin, we proposed a new and comprehensive classification based on CT scan for the LTPF. We retrospectively reviewed 42 patients involving LTPF. All fractures were classified according to Hawkins, McCrory-Bladin and new proposed classification system by three surgeons. The analysis of interobserver and intraobserver agreements was done using kappa statistics.Results: This new classification included two types based on presence of concomitant injuries or not, with type I consisting of three subtypes and type II of five subtypes. Interobserver and intraobserver reliability of the new classification system were almost perfect (κ=0.846 and 0.823, respectively)，showing a higher interobserver and intraobserver reliability compared to the Hawkins classification (κ=0.737 and 0.689, respectively) as well as McCrory-Bladin classification (κ=0.748 and 0.714, respectively). Conclusion: This new classification system for the LTPF based on CT is a comprehensive classification considering concomitant injuries. It is more reliable and reproducible and can potentially become a useful instrument for decision making of treatment options for LTPFs. Further studies on the evaluation of their clinical relevance (especially the long-term outcome) are warranted.

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